Provider Demographics
NPI:1619918133
Name:PECHA, ROBERT ERICK (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERICK
Last Name:PECHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 CREEKSIDE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3888
Mailing Address - Country:US
Mailing Address - Phone:916-983-4444
Mailing Address - Fax:916-983-8563
Practice Address - Street 1:1580 CREEKSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3888
Practice Address - Country:US
Practice Address - Phone:530-644-6430
Practice Address - Fax:530-622-3957
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G745701Medicaid
CAZZZ20819ZMedicare PIN
CA00G745701Medicaid
CA00G745700Medicare PIN
CAF92236Medicare UPIN